“Surgical error” is inherent to the drilling of the osteotomy sites and the subsequent insertion of the implant fixtures, and, more often than not, results in implants being placed at a less than an ideal vertical angle or horizontal position. Some of the causes of the vertical angulation/position issue include tilting a hand piece by even just a few degrees, which can result in the head of the implant being misdirected several or more millimeters away from its intended position; drilling osteotomy sites without using a surgical guide, which can result in random implant fixture placement; and compensating for existing natural bony undercuts by angling the drill during site preparation. Any one of these errors can dramatically alter the implant's position away from its intended ideal location.
However, while vertical angulation can be an impediment to easy fabrication of implant abutments and/or prostheses with natural anatomic form, the most insidious and compounding problem is the misalignment of the implants' indexes. This misalignment results from arbitrary insertion of the implants by a surgeon, as the surgeon's first priority is properly securing the implants to the bone. In securing an implant to the bone, the surgeon is solely concerned with either sufficiently tightening the implant without over-tightening and thereby potentially stripping the bone during the tightening procedure, or with placing the implant at the crest of bone or below it as a first priority. An implant that has been over-tightened or under-tightened is at risk of failure. Because proper securement of the implant is the primary, if not only, consideration of the surgeon, the surgeon cannot guarantee that the implants' indexes are situated so that their axes bisect the ridge in the sagittal plane at their center points. In fact, this frequent misalignment of the indexes magnifies vertical angle and positional issues, especially as the number of sides of the implant index decrease, which severely limits the rotational options to increasingly coarse increments. For example, a dodecagon with twelve sides has a 30° rotation, an octagon with eight sides exhibits a 45° rotation, a hexagon with six sides turns with a 60° rotation, and a tripod with three sides has a 120° rotation which, at a minimum, requires altered six sided abutments just to achieve a 60° rotation (see FIGS. 13-23).
To varying degrees, even experienced practitioners can find it challenging to fabricate restorations that are not too bulky or that have access holes in locations that are not too difficult to manipulate (see FIGS. 62-69C). As a result of these issues, implant companies have gone to great lengths to compensate for these “off-angle” implants with abutment and prosthesis products that by-pass these misaligned indexes, have anatomic forms that have to be cast or milled from the bottom up to compensate for the misalignment; or have connecting cylinders that lack anti-rotation features to avoid parallelism issues, to name just a few.
The universal system of the present application resolves these angulation/misalignment problems for all implants by rotating the abutments and/or prosthetic components in 15° increments or less, regardless of whether the implant's index is a dodecagon (23), octagon (24), hexagon (22), nonagon (25), quadragon (not shown) or even a trichannel (21) (see FIGS. 13-23). As shown in FIGS. 2 and 3, the implant's index (15) comprises an internal mating surface which is intended to pair with an external mating surface of the corresponding index of the adaptor.
In certain embodiments, the abutment/adaptor assembly achieves an optimal positioning within a maximal 7.5° deviation from the ideal direction when rotating in 15° increments. Along with this repositioning capability, the universal system can realign the implant indexes such that the abutments, healing caps, impression posts, scanning posts, and screw access holes are situated and aligned by the newly reestablished relationship of the primary and secondary indicia of the universal aligning adaptor and its prosthetic components having co-operable indices.
The innovative devices and methods to be used in conjunction with the universal aligning adaptor to realign, situate, and standardize abutment placement; to synchronize all prosthetic components, and to reference them is described below.